scholarly journals The Effects of Modified Graded Recession, Anteriorization and Myectomy of Inferior Oblique Muscles on Superior Oblique Muscle Palsy

2021 ◽  
Vol 10 (19) ◽  
pp. 4433
Author(s):  
Yu-Te Huang ◽  
Jamie Jiin-Yi Chen ◽  
Ming-Yen Wu ◽  
Peng-Tai Tien ◽  
Yung-Ping Tsui ◽  
...  
Keyword(s):  
Torsion Angle ◽  
Head Tilt ◽  
Rectus Muscle ◽  
Clinical Results ◽  
Oblique Muscle ◽  
Torsional Angle ◽  
Ocular Torsion ◽  
Vertical Deviation ◽  
Superior Oblique Muscle ◽  
Superior Oblique

Background: The aim was to investigate the effect of inferior oblique (IO) operation (IO myectomy or graded recession and anteriorization) for unilateral and bilateral superior oblique muscle palsy (SOP); Methods: A total of 167 eyes undergoing IO surgery by a single surgeon between 2008 and 2015 were retrospectively reviewed. The method for treating symmetric bilateral SOP was bilateral IO myectomy (n = 102) and the method for treating unilateral SOP or non-symmetric bilateral SOP was IO-graded recession and anteriorization (n = 65). Associated clinical results and other factors were analyzed; Results: Head tilt, vertical deviation, IO overaction, SO underaction degree and ocular torsion angle were all clearly changed, but there was no statistically significance between these two procedures. Mean preoperative torsional angle was 15.3 ± 6.4 degree, which decreased to 5.3 ± 2.7 degree after surgery. Preoperative torsional angle, IOOA and SOUA degree were all significantly affected in postoperative torsional angle (p = 0.025, 0.003 and 0.038). Horizontal rectus muscle and IO muscle operation did not interfere with each other’s results (p = 0.98); Conclusions: Symmetric bilateral SOP could be treated with bilateral IO myectomy and IO-graded recession and anteriorization should be reserved for unilateral SOP or non-symmetric bilateral SOP.

Asymmetric superior oblique split Z-tendon lengthening for face turn in bilateral asymmetric superior oblique overaction and exotropia

2020 ◽  
pp. 112067211989798
Author(s):  
Massimiliano Serafino ◽  
Matteo Scaramuzzi ◽  
Claudia Specchia ◽  
Francesco Bonsignore ◽  
Paolo Nucci
Keyword(s):  
Oblique Muscle ◽  
Intermittent Exotropia ◽  
Left Turn ◽  
Vertical Deviation ◽  
Tendon Lengthening ◽  
The Face ◽  
The Right ◽  
Clinical Records ◽  
Superior Oblique Muscle ◽  
Superior Oblique

Introduction: The aim was to evaluate the effectiveness of the procedure of the superior oblique split Z-tendon lengthening to collapse A pattern and treat face turn in a cohort of patients with both incomitant intermittent exotropia and a vertical deviation associated with a bilateral asymmetric superior oblique overaction. Methods: We retrospectively reviewed the clinical records of patients with facial turn associated with intermittent exotropia and bilateral asymmetric superior oblique overaction, who underwent superior oblique muscle split tendon lengthening and concurrent horizontal surgery between 2009 and 2017. Results: A total of eight patients met the inclusion criteria. The preoperative average face turn was 26.8° (range, 20°–5°), and it significantly improved to 5.4° (range, 2°–8°) ( p < 0.05). All the patients showed an improvement in the face turn with neutralization of the vertical deviation. The vertical deviation in the right gaze for the patient with a right turn and the left gaze in patients with left turn improved significantly (values of p < 0.05). Conclusion: The superior oblique split Z-tendon lengthening was an effective procedure to collapse the A pattern and the treatment of the face turn in a cohort of patients with both incomitant intermittent exotropia and a vertical deviation associated with a bilateral asymmetric superior oblique muscle overaction with less complications, and less varying results.

scholarly journals Endoscopic Endonasal Approaches to the Medial Intraconal Space: Comparison of Transethmoidal and Prelacrimal Corridors

2020 ◽  
Vol 34 (6) ◽  
pp. 792-799
Author(s):  
Lifeng Li ◽  
Nyall R. London ◽  
Daniel M. Prevedello ◽  
Ricardo L. Carrau
Keyword(s):  
Rectus Muscle ◽  
Contralateral Side ◽  
Oblique Muscle ◽  
Average Height ◽  
Endoscopic Endonasal ◽  
Direct Exposure ◽  
Inferior Border ◽  
Optimal Approach ◽  
Superior Oblique Muscle ◽  
Superior Oblique

Background Endoscopic transethmoidal and prelacrimal approaches can access the medial intraconal space (MIS). Objective This study aimed to compare advantages and drawbacks of these two approaches, and to explore their appropriate indications for management of lesions at various locations within the MIS. Methods Six injected cadaveric specimens were dissected using an endonasal approach performing a transethmoidal approach on one side and a prelacrimal approach on the contralateral side. The MIS was divided into three Zones: Zone 1 was defined as the area above the superior border of the medial rectus muscle (MRM), Zone 2 as the area between the MRM and the optic nerve, and Zone 3 as the area below the inferior border of MRM. The exposure provided by these two approaches to various Zones within the MIS was assessed and compared. Results The average height of Zone 1 to 3 was 10.35 ± 0.45 mm, 11.07 ± 0.59 mm, and 6.53 ± 0.59 mm, respectively. Both approaches provided adequate exposure of Zone 2 and 3; however, the prelacrimal approach provided direct exposure of the posterosuperior aspect of Zone 2 without retraction of MRM. Retraction of MRM was unavoidable using a transethmoidal approach to enhance further exposure. Access to Zone 1 was adequately achieved through the corridor between superior oblique muscle and MRM via a transethmoidal corridor. Conclusion Conceptualizing the MIS into the three aforementioned Zones seems beneficial to select the optimal approach for lesions restricted to each specific Zone. Both the transethmoidal and prelacrimal approaches provide adequate exposure for select lesions in the MIS.

scholarly journals Factors influencing the result of superior oblique weakening procedures in patients with superior oblique overaction in horizontal strabismus

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Junwoo Chun ◽  
Seong-Joon Kim
Keyword(s):  
Success Rate ◽  
University Hospital ◽  
Oblique Muscle ◽  
Vertical Deviation ◽  
Surgical Success ◽  
Significant Difference ◽  
National University ◽  
Dissociated Vertical Deviation ◽  
Superior Oblique Muscle ◽  
Superior Oblique

Abstract Background Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from + 0.5 to + 3, and pre- and postoperative grades were recorded for all patients. Results The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p < 0.001). Conclusions There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.

scholarly journals Factors influencing the result of superior oblique weakening procedures in patients with superior oblique overaction in horizontal strabismus

2020 ◽  
Author(s):  
Junwoo Chun ◽  
Seong-Joon Kim
Keyword(s):  
Success Rate ◽  
University Hospital ◽  
Oblique Muscle ◽  
Vertical Deviation ◽  
Surgical Success ◽  
Significant Difference ◽  
National University ◽  
Dissociated Vertical Deviation ◽  
Superior Oblique Muscle ◽  
Superior Oblique

Abstract Background: Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods: The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from +0.5 to +3, and pre- and postoperative grades were recorded for all patients. Results: The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p<0.001). Conclusions: There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.

scholarly journals Vertical Strabismus and Positive Bielschowsky Head-Tilt Test: Atypical Presentation of a Maxillary Mucocele

2021 ◽  
Author(s):  
Filipe André Correia ◽  
Gustavo Filipe Antunes de Almeida ◽  
Carolina Fernandes Pereira Bruxelas ◽  
Pedro Alberto Batista Brissos de Sousa Escada
Keyword(s):  
Head Tilt ◽  
Visual Disturbance ◽  
Oblique Muscle ◽  
Tilt Test ◽  
History Of ◽  
Vestibular Symptoms ◽  
Binocular Diplopia ◽  
Superior Oblique Muscle ◽  
Cover Test ◽  
Superior Oblique

AbstractTest of skew has become a cornerstone in the approach of a patient with vestibular symptoms but a detected vertical misalignment may be caused by an oculomotor disturbance and not a skew deviation. We report the case of an elderly patient with a 1-month history of dizziness and visual disturbance that revealed on bedside examination a spontaneous left head-tilt and a pathologic alternate cover test, with right eye hypertropia and excyclotorsion, worse with right head-tilt. Dizziness was assumed to have a visual origin with unrecognized binocular diplopia, caused by an acquired right eye superior oblique muscle palsy. However, imaging revealed a right maxillary mucocele that eroded the orbit floor into the orbit. The change of the intraorbital component of the maxillary fluid-filled mass with head-tilt through a dehiscent orbital floor may explain the findings of vertical strabismus and positive Bielschowsky head-tilt test in this case. Endoscopic treatment improved symptoms and findings.

scholarly journals Factors Influencing the Result of Superior Oblique Weakening Procedures in Patients with Superior Oblique Overaction in Horizontal Strabismus

2020 ◽  
Author(s):  
Junwoo Chun ◽  
Seong-Joon Kim
Keyword(s):  
Success Rate ◽  
University Hospital ◽  
Oblique Muscle ◽  
Vertical Deviation ◽  
Surgical Success ◽  
Significant Difference ◽  
National University ◽  
Dissociated Vertical Deviation ◽  
Superior Oblique Muscle ◽  
Superior Oblique

Abstract Background Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from +0.5 to +3, and pre- and postoperative grades were recorded for all patients. Results The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p<0.001). Conclusion There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.

scholarly journals Factors Influencing the Result of Superior Oblique Weakening Procedures in Patients with Superior Oblique Overaction in Horizontal Strabismus

2020 ◽  
Author(s):  
Junwoo Chun ◽  
Seong-Joon Kim
Keyword(s):  
Success Rate ◽  
University Hospital ◽  
Oblique Muscle ◽  
Vertical Deviation ◽  
Surgical Success ◽  
Significant Difference ◽  
National University ◽  
Dissociated Vertical Deviation ◽  
Superior Oblique Muscle ◽  
Superior Oblique

Abstract Background Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from +0.5 to +3, and pre- and postoperative grades were recorded for all patients. Results The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p<0.001). Conclusion There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.

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